Background Sub-Saharan Africa is one of the highest under-five mortality and low childhood immunization region in the world. Children in Sub-Saharan Africa are 15 times more likely to die than children from high-income countries. In sub-Saharan Africa, more than half of under-five deaths are preventable through immunization. Therefore, this study aimed to identify the determinant factors of full childhood immunization among children aged 12–23 months in sub-Saharan Africa. Methods Data for the study was drawn from the Demographic and Health Survey of nine sub-Saharan African countries. A total of 21,448 children were included. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with full childhood immunization Result The prevalence of full childhood immunization coverage in sub-Saharan Africa countries was 59.40% (95% CI: 58.70, 60.02). The multilevel logistic regression model revealed that secondary and above maternal education (AOR = 1.38; 95% CI: 1.25, 1.53), health facility delivery (AOR = 1.51; 95% CI: 1.41, 1.63), fathers secondary education and above (AOR = 1.28, 95% CI: 1.11, 1.48), four and above ANC visits (AOR = 2.01; 95% CI: 1.17, 2.30), PNC visit(AOR = 1.55; 95% CI: 1.46, 1.65), rich wealth index (AOR = 1.26; 95% CI: 1.18, 1.40), media exposure (AOR = 1.11; 95% CI: 1.04, 1.18), and distance to health facility is not a big problem (AOR = 1.42; 95% CI: 1.28, 1.47) were significantly associated with full childhood immunization. Conclusion The full childhood immunization coverage in sub-Saharan Africa was poor with high inequalities. There is a significant variation between SSA countries in full childhood immunization. Therefore, public health programs targeting uneducated mothers and fathers, rural mothers, poor households, and those who have not used maternal health care services to promote full childhood immunization to improve child health. By enhancing institutional delivery, antenatal care visits and maternal tetanus immunization, the government and other stakeholders should work properly to increase child immunization coverage. Furthermore, policies and programs aimed at addressing cluster variations in childhood immunization need to be formulated and their implementation must be strongly pursued.

Background In sub-Saharan African countries, neonatal mortality rates remain unacceptably high. Ethiopia is one of the countries in Sub-Saharan Africa with the highest death rates of newborn children. Therefore, this study aimed to identify the risk factors associated with neonatal mortality in Ethiopia at the individual and community level. Methods The 2016 Ethiopian Demographic and Health Survey data was accessed and used for the analysis. A total of 2449 newborn children were included in the analysis. The multilevel logistic regression model was used to identify the significant factor of neonatal mortality. Adjusted odds ratio with a 95% confidence interval and p-value < 0.05 in the multilevel model was reported. Results A total of 2449 newborn children were included in this study. Multiple birth type (AOR = 3.18; 95% CI 2.78, 3.63), birth order of ≥ 5 (AOR = 2.15; 95% CI 1.75, 2.64), pre-term birth (AOR = 5.97; 95% CI 4.96, 7.20), no antenatal care (ANC) visit during pregnancy (AOR = 2.33; 95% CI 2.09, 2.61), not received TT injection during pregnancy (AOR = 2.28; 95% CI 1.92, 2.71), delivered at home (AOR = 1.99; 95% CI 1.48, 2.69), less than 24 months of preceding birth interval (AOR = 1.51; 95% CI 1.35,1.68), smaller birth size (AOR = 1.58; 95% CI 1.46, 1.71), never breastfeeding (AOR = 2.43; 95% CI 2.17, 2.72), poor wealth index (AOR = 1.29; 95% CI 1.17,1.41), non-educated mothers (AOR = 1.58; 95% CI 1.46, 1.71), non-educated fathers (AOR = 1.32; 95% CI 1.12, 1.54), rural residence (AOR = 2.71; 95% CI 2.23, 3.29), unprotected water source (AOR = 1.35; 95% CI 1.16, 1.58), and have no latrine facility (AOR = 1.78; 95% CI 1.50, 2.12) were associated with a higher risk of neonatal mortality. Neonates living in Amhara, Oromia, Somali, Harari, and Dire Dawa had a higher risk of neonatal mortality compared to Tigray. Moreover, the random effects result showed that about 85.57% of the variation in neonatal mortality was explained by individual- and community-level factors. Conclusions The findings suggest that attention be paid to education-based programs for mothers that would highlight the benefits of delivery care services, such as ANC visits, TT injections, and facility births. Meanwhile, public health initiatives should focus on expanding access to quality sanitation facilities, especially for latrines and drinking water that could improve neonatal health at the community-level as a whole.

Background Post-neonatal mortality is the number of deaths of infants aged 28 days through 11 months and is expressed as post-neonatal deaths per 1000 live births per year. This study aimed to identify the factors that influence post-neonatal death using the 2019 Ethiopia mini demographic and health survey (EMDHS2019). Methods The study included 2126 post neonates born from mothers who had been interviewed about births in the five years before the survey. The survey gathering period was carried out from March 21, 2019, to June 28, 2019. The data were first analyzed with a chi-square test of association, and then relevant factors were evaluated with binary logistic regression models and the results were interpreted using adjusted odds ratio (AOR) and confidence interval(CI) of parameters. Results The prevalence of post neonatal death was 16% (95% CI: 15.46, 17.78). The study also showed that not vaccinated post-neonates (AOR = 2.325, 95% CI: 1.784, 3.029), mothers who were not receiving any tetanus injection (AOR = 2.891, 95% CI: 2.254, 3.708), mothers age group 15-24(AOR = 1.836, 95% CI: 1.168, 2.886), Afar (AOR = 2.868, 95% CI: 1.264, 6.506), Somali(AOR = 2.273, 95% CI: 1.029, 5.020), Southern Nations, Nationalities, and People’s Region(SNNP) (AOR = 2.619, 95% CI: 1.096, 6.257), 2–4 birth orders (AOR = 1.936, 95% CI: 1.225, 3.060), not attend antenatal care(ANC) visit (AOR = 6.491, 95% CI: 3.928, 10.726), and preceding birth interval less than 24 months (AOR = 1.755, 95% CI: 1.363,2.261) statistically associated with a higher risk of post neonatal death. Although not given anything other than breast milk (AOR = 0.604, 95% CI 0.462, 0.789), urban residents (AOR = 0.545, 95% CI: 0.338, 0.877), single births (AOR = 0.150, 95% CI: 0.096, 0.234), less than 3 children in a family (AOR = 0.665, 95% CI 0.470, 0.939) and the head of the male household (AOR = 0.442, 95% CI: 0.270, 0.724) were statistically associated with a lower risk of post-neonatal mortality. Conclusions It is highly suggested that maternal and child health care services (including antenatal care visits, postnatal care visits, and immunization) be strengthened and monitored during the early stages of infancy. Mothers from Somali, Afar, and SNNP regions, as well as multiple births, rural residents, and those giving birth to a child with a birth gap of fewer than 24 months, demand special care.

Background The survival of pregnant women is one of great interest of the world and especially to a developing country like Ethiopia which had the highest maternal mortality ratios in the world due to low utilization of maternal health services including antenatal care (ANC). Survival analysis is a statistical method for data analysis where the outcome variable of interest is the time to occurrence of an event. This study demonstrates the applications of the Accelerated Failure Time (AFT) model with gamma and inverse Gaussian frailty distributions to estimate the effect of different factors on time to first ANC visit of pregnant women in Ethiopia. Methods This study was conducted by using 2016 EDHS data about factors associated with the time to first ANC visit of pregnant women in Ethiopia. A total of 4328 women from nine regions and two city administrations whose age group between 15 and 49 years were included in the study AFT models with gamma and inverse Gaussian frailty distributions have been compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) to select the best model. Results The factors residence, media exposure, wealth index, education level of women, education level of husband and husband occupation are found to be statistically significant (P-value < 0.05) for the survival time of time to first ANC visit of pregnant women in Ethiopia. Inverse Gaussian shared frailty model with Weibull as baseline distribution is found to be the best model for the time to first ANC visit of pregnant women in Ethiopia. The model also reflected there is strong evidence of the high degree of heterogeneity between regions of pregnant women for the time to first ANC visit. Conclusion The median time of the first ANC visit for pregnant women was 5 months. From different candidate models, Inverse Gaussian shared frailty model with Weibull baseline is an appropriate approach for analyzing time to first ANC visit of pregnant women data than without frailty model. It is essential that maternal and child health policies and strategies better target women’s development and design and implement interventions aimed at increasing the timely activation of prenatal care by pregnant women. The researchers also recommend using more powerful designs (such as cohorts) for the research to establish timeliness and reduce death.

Background: Human immune virus/tuberculosis co-infection in one's immune system potentiates each other and hastening the weakening of the host's immunological capabilities while growing active TB, which will increase susceptibility to primary contamination, re-contamination, and/or reactivation for sufferers with latent TB. The goal of this study was to identify determinant factors associated with the survival time to death of HIV/TB co-infected adult patients under HAART at Debre Tabor referral hospital. Methods: A retrospective follow-up analysis was undertaken for 243 HIV/TB coinfected patients who were receiving ART treatment and had follow-ups between January 2014 and December 2019. To compare the survival experiences of different patient groups, the Log rank test was performed. The Weibull accelerated failure time gamma shared frailty model was used to find determinants of HIV/TB co-infected patients' survival time. Results: Among HIV/TB co-infected patients, 87 (35.39%) died of whom 77 (88.5%) patients were females. The Weibull AFT gamma shared frailty model showed that sex, baseline age, adherence status, educational status of respondents, functional status, WHO clinical stage, baseline hemoglobin and type of TB were among the potential determinants of survival time of HIV/TB co-infected patients. Furthermore, the findings of this study demonstrated that there is a clustering impact on patient time to death that results from the residency of HIV/TB co-infected patients' survival time. Conclusion and Recommendation:The majority of patients reside in rural area, have poor adherence to treatment, and have low CD4 cell counts. Educational status, WHO clinical stages, adherence status, and hemoglobin levels of patients are all important determinants of HIV/TB co-infected patients' survival. As a result, to improve the survival of HIV/TB co-infected patients at the start of and during some stages of anti-TB treatment, the concerned body, FMOH, in collaboration with Regional Health Bureau, should emphasize the importance of following treatment for HIV/TB coinfected patients with poor adherence status, advanced WHO clinical stages, and a low CD4+ count.

Background Mycobacterium leprae causes leprosy, which is a long-term or recurrent infection. The causative agent’s collusion with Schwann cells results in the irreversible loss of fringe nerve tissue; followed by incapacity, which includes not just actual impotence but also mental incapacity, creates a bad image of the transformed, resulting in segregation and societal humiliation of leprosy patients, as well as their families. Methods This study’s survival analysis includes a sample of 205 patients who were taking leprosy medication and had all essential data from January 2015 to December 2019 G.C. at the All African TB and Leprosy Rehabilitation and Training Centre. The Cox proportional hazard model was used to figure out what factors influence leprosy patients’ survival status during treatment. Results Among the 205 leprosy patients, 71 (34.63%) had at least one type of impairment grade during treatment. The Cox proportional model revealed that the most significant variables of impairment among leprosy patients were age, symptom duration, treatment category, living place, and sensory loss. Conclusion The study investigated and revealed characteristics associated with the survival status of leprosy patients in ALRT centers using survival analysis. Patients’ risk of worsening disability grade increased with age, was greater for patients with a long duration of symptom, was higher for defaulter patients, and was lower for patients who did not lose their sensibility throughout therapy. The existence of a difference in the survival curves between two or more groups of factors for the patient’s survival function was also discovered in this inquiry. Female patients, particularly those who were new to the medication, were shown to be more in their survival.

Background Appropriate contraceptive use prevents unintended pregnancy, protects the health of mother and child, and promotes women’s well-being. Use of modern Family planning in Ethiopia was still very low. The purpose of this study was to assess the factors that are associated with non-use of modern family planning services among women of reproductive age. Method A nationally representative 2016 EDHS women data were used for analysis. A total of 15,683 women in the reproductive age group were included in this study. Descriptive and multilevel multivariable binary logistic regression models were used to summarize descriptive data and measure statistical association between the dependent and the individual and community level variable, respectively. Adjusted Odds Ratio (AOR) and confidence interval were respectively used to measure association and its statistical significance. Result Among women in the reproductive age group 79.49% (95% CI: 78.85%, 80.12%) did not use a modern contraceptive method. Women age between 25–34 years (AOR = 0.54, 95% CI: 0.47–0.61) and age between 34–49 year (AOR = 0.62, 95% CI: 0.55–0.71), having primary educated women (AOR = 0.0.77, 95% CI: 0.68–0.87),secondary and above educational (AOR = 0.88, CI: 0.75–1.03), Secondary and above-educated husband (AOR = 0.84, 95% CI: 0.72–0.96), rich women (AOR = 0.74,95%CI:0.65–0.85), health facility delivery (AOR = 0.84, 95%CI: 0.73–0.0.98), being watching TV (AOR = 0.74, 95% CI: 0.65–0.85), having 1–2 living children (AOR = 0.21, 95% CI: 0.19–0.23) are less likely to not use contraception were identified. Furthermore, Muslim women (AOR = 1.43, 95% CI: 1.23–1.62), women living in rural area (AOR = 3.43; 95% CI: 2.72–4.32), and ANC visit 1.25(1.07–1.47) were more likely to not use contraception. Further, Women in Afar, Somali, Gambela, Harari, and Dire Dawa were less likely to use modern contraception methods than women in Tigray, but Amhara region had a lower rate of non-use. Conclusion Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. Moreover, initiatives to empower women associated to family planning programs would be beneficial in increasing contraceptive uptake among sexually active women in Ethiopia.

The infant mortality rate remains unacceptably high in sub-Saharan African countries. Ethiopia has one of the highest rates of infant death. This study aimed to identify individual-and community-level factors associated with infant death in the rural part of Ethiopia. The data for the study was obtained from the 2016 Ethiopian Demographic and Health Survey. A total of 8667 newborn children were included in the analysis. The multilevel logistic regression model was considered to identify the individual and community-level factors associated with new born mortality. The random effect model found that 87.68% of the variation in infant mortality was accounted for by individual and community level variables. Multiple births (AOR = 4.35; 95%CI: 2.18, 8.69), small birth size (AOR = 1.29; 95%CI: 1.10, 1.52), unvaccinated infants (AOR = 2.03; 95%CI: 1.75, 2.37), unprotected source of water (AOR = 1.40; 95%CI: 1.09, 1.80), and non-latrine facilities (AOR = 1.62; 95%CI: 1.20) were associated with a higher risk of infant mortality. While delivery in a health facility (AOR = 0.25; 95%CI: 0.19, 0.32), maternal age 35–49 years (AOR = 0.65; 95%CI: 0.49, 0.86), mothers receiving four or more TT injections during pregnancy (AOR = 0.043, 95% CI: 0.026, 0.071), and current breast feeders (AOR = 0.33; 95% CI: 0.26, 0.42) were associated with a lower risk of infant mortality. Furthermore, Infant mortality rates were also higher in Afar, Amhara, Oromia, Somalia, and Harari than in Tigray. Infant mortality in rural Ethiopia is higher than the national average. The government and other concerned bodies should mainly focus on multiple births, unimproved breastfeeding culture, and the spacing between the orders of birth to reduce infant mortality. Furthermore, community-based outreach activities and public health interventions focused on improving the latrine facility and source of drinking water as well as the importance of health facility delivery and received TT injections during the pregnancy.